Delayed Meal Service on Memory Care Unit
Penalty
Summary
The facility failed to ensure that meals were served in a timely manner on the Memory Care Unit, affecting all 33 residents residing there. Multiple interviews with residents' families, CNAs, dietary staff, and supervisors confirmed that meal trays were consistently late, with reports indicating delays of up to an hour. Direct observation showed residents seated and waiting for their lunch meals well past the scheduled delivery time, with the first meal cart arriving at 12:37 P.M. instead of the scheduled 12:00 P.M. for the first cart and 12:15 P.M. for the second cart. Staff interviews corroborated that late meal service was a recurring issue. Review of facility policies revealed that meal trays were expected to be delivered promptly to ensure freshness and quality, with specific delivery times outlined for the Memory Care Unit. Despite these policies, both dietary and nursing staff acknowledged that meals were not being served on time, and no specific reasons for the delays were consistently identified other than general untimeliness. The deficiency was substantiated through direct observation, staff and family interviews, and policy review, confirming non-compliance with established meal service protocols.